Showing papers in "Annals of Internal Medicine in 1996"
TL;DR: The events leading to the acquisition of HIV and the initial clinical and diagnostic evaluation of 46 patients with primary HIV infection are summarized.
Abstract: Background: The acute clinical events surrounding the acquisition of human immunodeficiency virus (HIV) have not been well characterized. Objective: To further define the clinical and epidemiologic...
3,331 citations
TL;DR: The clinical course of a first episode of symptomatic deep venous thrombosis in a large consecutive series of patients who had long-term follow-up was assessed and the potential risk factors for these three outcomes were evaluated.
Abstract: Background: In patients who have symptomatic deep venous thrombosis, the long-term risk for recurrent venous thromboembolism and the incidence and severity of post-thrombotic sequelae have not been...
1,989 citations
TL;DR: Surrogate end points are rarely, if ever, adequate substitutes for the definitive clinical outcome in phase 3 trials and proper justification for such replacement requires that the effect of the intervention on the surrogate end point predicts the effect on the clinical outcome.
Abstract: Phase 3 clinical trials, which evaluate the effect that new interventions have on the clinical outcomes of particular relevance to the patient (such as death, loss of vision, or other major symptom...
1,510 citations
TL;DR: It is true that the underlying inflammatory reaction is vastly more complicated than the authors had thought, and it is unlikely that a magic bullet will be found soon, but by reexamining what they have learned and rethinking their assumptions, they can better understand how organ dysfunction develops and how to prevent it.
Abstract: Our current understanding of sepsis and multiple organ dysfunction needs to be revised, as the uniformly negative results of new therapies for these disorders suggest. Previous theories for the pathogenesis of these conditions are incomplete; reasons for this include the following. First, the surrogate models that have been used to study these disorders are not analogous to the clinical situation. Second, patients who have less severe manifestations of these diseases are often overlooked. And third, patients' preexisting conditions have not been taken into account. Considerable new evidence indicates that, in addition to a massive proinflammatory reaction, a compensatory anti-inflammatory response contributes to the onset of these disorders. At a local site of injury or infection and during the initial appearance of pro- and anti-inflammatory mediators in the circulation, the beneficial effects of these mediators outweigh their harmful effects. Only when the balance between these two forces is lost do these mediators become harmful. Sequelae of an unbalanced systemic proinflammatory reaction include shock, transudation into organs, and defects in coagulation. An unbalanced systemic compensatory anti-inflammatory response can result in anergy and immunosuppression. The proinflammatory and anti-inflammatory forces may ultimately reinforce each other, creating a state of increasingly destructive immunologic dissonance.
735 citations
TL;DR: Anthracyclines are clearly an important independent risk factor leading to both early and delayed congestive heart failure in survivors of cancer, and late-onset cardiomyopathy depends on the cumulative dose of the drug.
Abstract: Purpose: To review the current understanding of the clinical significance, detection, pathogenesis, and prevention of anthracycline-induced cardiotoxicity. Data Sources: A MEDLINE search of the Eng...
702 citations
TL;DR: Patients faced with serious medical decisions are subject to being over- or under-influenced by physicians, and data from SUPPORT suggest that the dominant mode of decision making in acute care hospitals may still be the paternalism evidenced by Dr. Able.
Abstract: Medical care in the United States has rapidly moved away from a paternalistic approach to patients and toward an emphasis on patient autonomy. At one extreme end of this spectrum is the "independent choice" model of decision making, in which physicians objectively present patients with options and odds but withhold their own experience and recommendations to avoid overly influencing patients. This model confuses the concepts of independence and autonomy and assumes that the physician's exercise of power and influence inevitably diminishes the patient's ability to choose freely. It sacrifices competence for control, and it discourages active persuasion when differences of opinion exist between physician and patient. This paper proposes an "enhanced autonomy" model, which encourages patients and physicians to actively exchange ideas, explicitly negotiate differences, and share power and influence to serve the patient's best interests. Recommendations are offered that promote an intense collaboration between patient and physician so that patients can autonomously make choices that are informed by both the medical facts and the physician's experience.
689 citations
TL;DR: In this article, a double-blind trial was conducted to determine whether vitamin D supplementation decreases the incidence of hip fractures and other peripheral bone fractures in Dutch elderly persons living independently, in apartments for elderly persons, or in homes for elderly people.
Abstract: OBJECTIVE: To determine whether vitamin D supplementation decreases the incidence of hip fractures and other peripheral bone fractures. DESIGN: Prospective, double-blind trial. SETTING: Community setting (Amsterdam and surrounding area). PATIENTS: 2578 persons (1916 women, 662 men) 70 years of age and older (mean age +/- SD, 80 +/- 6 years) living independently, in apartments for elderly persons, or in homes for elderly persons. INTERVENTION: Participants were randomly assigned to receive either vitamin D3, 400 IU in one tablet daily, or placebo for a maximum of 3.5 years. MEASUREMENTS: Dietary calcium intake and serum 25-hydroxyvitamin D [25(OH)D] were estimated in a subset of participants. During follow-up, attention was concentrated on hip fractures and other peripheral fractures. The maximal follow-up period was 4 years. The results were evaluated by survival analysis. RESULTS: Mean dietary calcium intake from dairy products was 868 mg/d. Mean serum 25(OH)D concentration in the third year of the study was 23 nmol/L in the placebo group and 60 nmol/L in the vitamin D group. Median follow-up was 3.5 years, and total follow-up was 8450 patient-years. During follow-up, 306 persons in the placebo group and 282 persons in the vitamin D group died (P = 0.20). Hip fractures occurred in 48 persons in the placebo group and 58 persons in the vitamin D group (P = 0.39, intention-to-treat analysis). Other peripheral fractures occurred in 74 persons in the placebo group and 77 persons in the vitamin D group (P = 0.86). CONCLUSION: Our results do not show a decrease in the incidence of hip fractures and other peripheral fractures in Dutch elderly persons after vitamin D supplementation. Language: en
654 citations
TL;DR: To amplify and identify the HSV, varicella-zoster virus, and Epstein-Barr virus genomes, five sets of virus-specific primers and internal oligonucleotide probes were synthesized for PCR and Southern blot analysis.
Abstract: Objective: To determine whether herpes simplex virus type 1 (HSV-1) causes Bell palsy. Design: Prospective study. Setting: University inpatient service. Patients: 14 patients with Bell palsy, 9 pat...
650 citations
TL;DR: Patients whose physicians were less controlling and more participatory during office visits had better functional status and lower follow-up glycosylated hemoglobin levels, blood pressure, and arthritis severity than patients of less participatory physicians, suggesting that physicians vary widely in how much they facilitate patients' active participation in treatment decisions.
Abstract: Objectives: To identify physician and practice characteristics associated with a physician's propensity to involve patients in diagnostic and treatment decisions, or participatory decision-making s
625 citations
TL;DR: The efficacy of dietary protein restriction in slowing the progression of either diabetic or nondiabetic renal diseases was defined and changes in glomerular filtration rate, creatinine clearance, or urinary albumin excretion rate were determined.
Abstract: Background : Dietary protein has long been thought to play a role in the progression of chronic renal disease, but clinical trials to date have not consistently shown that dietary protein restriction is beneficial. Purpose : To use meta-analysis to assess the efficacy of dietary protein restriction in previously published studies of diabetic and nondiabetic renal diseases, including the recently completed Modification of Diet in Renal Disease Study. Data Sources : The English-language medical literature published from January 1966 through December 1994 was searched for studies examining the effect of low-protein diets in humans with chronic renal disease. A total of 1413 patients in five studies of nondiabetic renal disease (mean length of follow-up, 18 to 36 months) and 108 patients in five studies of type I diabetes mellitus (mean length of follow-up, 9 to 35 months) were included. Study Selection : Randomized, controlled studies were selected for nondiabetic renal disease ; randomized, controlled studies or time-controlled studies with nonrandomized crossover design were selected for diabetic nephropathy. Data Extraction : Data in tables, figures, or text were independently extracted by two of the authors. Data Synthesis : The relative risk for progression of renal disease in patients receiving a low-protein diet compared with patients receiving a usual-protein diet was calculated by using a random-effects model. In five studies of nondiabetic renal disease, a low-protein diet significantly reduced the risk for renal failure or death (relative risk, 0.67 [95% CI, 0.50 to 0.89]). In five studies of insulin-dependent diabetes mellitus, a low-protein diet significantly slowed the increase in urinary albumin level or the decline in glomerular filtration rate or creatinine clearance (relative risk, 0.56 [Cl, 0.40 to 0.77]). Tests for heterogeneity showed no significant differences in relative risk among studies of either diabetic or nondiabetic renal disease. No significant differences were seen between diet groups in pooled mean arterial blood pressure (diabetic and nondiabetic patients) or glycosylated hemoglobin level (diabetic patients only). Conclusion : Dietary protein restriction effectively slows the progression of both diabetic and nondiabetic renal diseases.
593 citations
TL;DR: For more than a decade, LDS Hospital has been developing and investigating clinical management programs that augment and inform clinical decision making, in addition to focusing on continual quality improvement in antibiotic therapy, infection control surveillance, and the safety of drug use.
Abstract: Objective: To determine the clinical and financial outcomes of antibiotic practice guidelines implemented through computer-assisted decision support. Design: Descriptive epidemiologic study and fin...
TL;DR: This study analyzed data from six anticoagulation clinics to determine whether elderly patients who were receiving warfarin had a higher incidence of complications than similar younger patients who are also receiving warFarin.
Abstract: Objective: To determine whether increasing age is associated with an increased risk for bleeding during warfarin treatment. Design: Combined retrospective and prospective cohort studies. Setting: 6...
TL;DR: The association between intake of flavonols and flavones and coronary heart disease in 34 789 men who were enrolled in the Health Professionals Follow-up Study and were followed prospectively for 6 years was investigated.
Abstract: Objective: Flavonols and flavones are subgroups of flavonoids and are found in tea, vegetables, fruits, and red wine. Because they have antioxidant properties, we investigated whether intake of the...
Journal Article•
TL;DR: The study design was modified from previous designs so that therapy could be intensified for patients with refractory or relapsing disease and some patients do not respond adequately to therapy with intermittent boluses of cyclophosphamide.
Abstract: Background: Uncertainty exists about the efficacy and toxicity of bolus therapy with methylprednisolone or of the combination of methylprednisolone and cyclophosphamide in the treatment of lupus ne...
TL;DR: In this article, the combination of methylprednisolone and cyclophosphamide was compared to bolus therapy alone and with combination therapy alone for the treatment of lupus nephritis.
Abstract: Background : Uncertainty exists about the efficacy and toxicity of bolus therapy with methylprednisolone or of the combination of methylprednisolone and cyclophosphamide in the treatment of lupus nephritis. Objective : To determine 1) whether intensive bolus therapy with methylprednisolone is an adequate substitute for bolus therapy with cyclophosphamide and 2) whether the combination of methylprednisolone and cyclophosphamide is superior to bolus therapy with methylprednisolone or cyclophosphamide alone. Design : Randomized, controlled trial with at least 5 years of follow-up. Setting : Government referral-based research hospital. Patients : 82 patients with lupus nephritis who had 10 or more erythrocytes per high-power field, cellular casts, proteinuria (>1 g of protein per day), and a renal biopsy specimen that showed proliferative nephritis. Interventions : Bolus therapy with methylprednisolone (1 g/m 2 body surface area), given monthly for at least 1 year ; bolus therapy with cyclophosphamide (0.5 to 1.0 g/m 2 body surface area), given monthly for 6 months and then quarterly ; or bolus therapy with both methylprednisolone and cyclophosphamide. Measurements : 1) Renal remission (defined as <10 dysmorphic erythrocytes per high-power field, the absence of cellular casts, and excretion of <1 g of protein per day without doubling of the serum creatinine level), 2) prevention of doubling of the serum creatinine level, and 3) prevention of renal failure requiring dialysis. Results : Renal remission occurred in 17 of 20 patients in the combination therapy group (85%), 13 of 21 patients in the cyclophosphamide group (62%), and 7 of 24 patients in the methylprednisolone group (29%) (P < 0.001). Twenty-eight patients (43%) did not achieve renal remission. By life-table analysis, the likelihood of remission during the study period was greater in the combination therapy group than in the methylprednisolone group (P = 0.028). Combination therapy and cyclophosphamide therapy were not statistically different. Adverse events were amenorrhea (seen in 41% of the cyclophosphamide group, 43% of the combination therapy group, and 7.4% of the methylprednisolone group), cervical dysplasia (seen in 11% of the cyclophosphamide group, 7.1% of the combination therapy group, and 0% of the methylprednisolone group), avascular necrosis (seen in 11% of the cyclophosphamide group, 18% of the combination therapy group, and 22% of the methylprednisolone group), herpes zoster (seen in 15% of the cyclophosphamide group, 21% of the combination therapy group, and 3.7% of the methylprednisolone group) and at least one infection (seen in 26% of the cyclophosphamide group, 32% of the combination therapy group, and 7.4% of the methylprednisolone group). Conclusions : Monthly bolus therapy with methylprednisolone was less effective than monthly bolus therapy with cyclophosphamide. A trend toward greater efficacy with combination therapy was seen.
TL;DR: This work reviews the available literature on prevalence, incidence, complications, mortality, and interventions in black persons, Hispanic persons, Native Americans, and Asians and Pacific Islanders in the United States and assesses the incidence of noninsulin-dependent diabetes mellitus and associated risk factors.
Abstract: PURPOSE: To review the available information on prevalence, complications, and mortality of non-insulin-dependent diabetes mellitus and primary and secondary prevention activities in black persons, Hispanic persons, Native Americans, and Asians and Pacific Islanders in the United States.
DATA SOURCE: MEDLINE search from 1976 to 1994 through the PlusNet search system.
STUDY SELECTION: Use of the key words non-insulin-dependent diabetes mellitus, the names of each specific minority group, socioeconomic status, acculturation, genetics, diet, complications, mortality, treatment, and intervention (lifestyle or medication) produced 290 unduplicated articles. Additional articles cited in the original articles were also included.
DATA EXTRACTION: Risk factors, incidence, prevalence, complications, and mortality of non-insulin-dependent diabetes mellitus.
DATA SYNTHESIS: All minorities, except natives of Alaska, have a prevalence of non-insulin-dependent diabetes mellitus that is two to six times greater than that of white persons. Most studies show an increased prevalence of nephropathy that can be as much as six times higher than that of white persons. Retinopathy has variably higher rates in black persons, Hispanic persons, and Native Americans. Amputations are done more frequently among black persons than among white persons (9.0 per 1000 compared with 6.3 per 1000), and Pima Indians have 3.7 times more amputations than do white persons. Diabetes-related mortality is higher for minorities than for white persons, and the rate is increasing. The relative importance of genetic heritage, diet, exercise, socioeconomic status, culture, language, and access to health care in the prevalence, incidence, and mortality of diabetes is not clear. Studies of interventions in minority populations are in progress.
CONCLUSION: Diabetes should be treated as a public health problem for minority populations.
TL;DR: The incidence, clinical manifestations, and natural history of cyclophosphamide-mediated urotoxicity in a cohort of patients with Wegener granulomatosis are described and recommendations for surveillance are discussed.
Abstract: Objective: To describe the incidence of, clinical manifestations of, and risk factors for cyclophosphamide-induced urinary bladder toxicity in patients treated for nonmalignant disease. Design: Ret...
TL;DR: This study sought to determine, using various diagnostic methods, whether C. pneumoniae was present in the coronary arteries of patients with coronary atherosclerosis, and whether these structures were compatible with Chlamydia organisms.
Abstract: Background: Atherosclerosis is pathologically similar to a chronic inflammatory response. Recent reports have suggested that Chlamydia pneumoniae may play a role in the pathogenesis of atherosclero...
Journal Article•
TL;DR: In this article, dietary protein has long been thought to play a role in the progression of chronic renal disease, but clinical trials to date have not consistently shown that dietary protein restrictio...
Abstract: Background: Dietary protein has long been thought to play a role in the progression of chronic renal disease, but clinical trials to date have not consistently shown that dietary protein restrictio...
TL;DR: The first-year results of a randomized clinical trial in which the delayed and the immediate introduction of SAARDs were compared are described and the consequences of ignoring the treatment pyramid for patients with recent-onset rheumatoid arthritis are investigated.
Abstract: Objective : To compare two therapeutic strategies for patients with recent-onset rheumatoid arthritis. Design : Open, randomized clinical trial. Setting : Outpatient clinics of six clinical centers. Patients : 238 consecutive patients with recently diagnosed rheumatoid arthritis. Interventions : Delayed or immediate introduction of treatment with slow-acting antirheumatic drugs (SAARDs). Measurements : Primary end points were functional disability, pain, joint score, and erythrocyte sedimentation rate at 6 and 12 months and progression of radiologic abnormalities at 12 months. Results : Statistically significant advantages at 12 months for patients receiving the SAARD strategy (immediate treatment with SAARDs) with regard to all primary end points that may be clinically important are indicated by the differences in improvements from baseline and their 95% Cls. These differences were 0.3 (95% CI, 0.2 to 0.6) for disability (range, 0 to 3), 10 mm (CI, 1 to 19 mm) for pain (range, 0 to 100 mm), 39 (CI, 4 to 74) for joint score (range, 0 to 534), and 11 mm/h (CI, 3 to 19 mm/h) for erythrocyte sedimentation rate (range, 1 to 140 mm/h), all in favor of SAARD treatment. The SAARD strategy also appears to be advantageous at 6 months. Radiologic abnormalities progressed at an equal rate in the SAARD and the non-SAARD groups ; the difference in progression (range, 0 to 448) was 1 (CI, -3 to 5). Analyses were based on the intention-to-treat principle and thus included 29% of patients in the non-SAARD group who discontinued the non-SAARD treatment strategy ; treatment was usually discontinued because of insufficient effectiveness. The SAARD strategy including two alternative SAARDs could not be continued by 8% of patients, usually because of adverse reactions. Conclusions : Early introduction of SAARDs may be more beneficial than delayed introduction for patients with recently diagnosed rheumatoid arthritis.
TL;DR: A 6-month randomized, controlled, double-blind trial comparing recombinant human growth hormone therapy with placebo in 56 elderly men whose baseline insulin-like growth factor 1 levels were less than the tenth percentile found in younger healthy adults was conducted.
Abstract: Objective: To determine whether growth hormone replacement in older men improves functional ability. Design: Randomized, controlled, double-blind trial. Setting: General community. Patients: 52 hea...
TL;DR: The outcome of infection of CD4-bearing target cells with HIV is dependent on complex interactions between viral and cellular factors and the mechanism of action involves the long terminal repeat (LTR) sequences of the HIV genome.
Abstract: The outcome of infection of CD4-bearing target cells with HIV is dependent on complex interactions between viral and cellular factors (Haseltine 1988). In addition to genes which code for the structural proteins of the virion and the enzymes which facilitate the transcription of viral RNA into DNA and the integration of the viral DNA into the host cell genome (Varmus 1988), the HIV genome contains at least six genes which act in distinct ways to regulate HIV replication. For several of these regulatory genes, the mechanism of action involves the long terminal repeat (LTR) sequences of the HIV genome. For example, the target for tat—mediated enhancement of viral replication is the trans-acting responsive (TAR) region of the LTR (Rosen et al 1985). The nef gene product has also been shown to regulate viral transcription by interacting with the negative regulatory element (NRE) of the LTR (Ahmad and Venkatesan 1988). In addition to TAR and NRE, the HIV LTR contains other regulatory sequences such as the TATAA promotor sequence, the NFkB core enhancer elements, and Sp-1 binding sites (Starcich et al 1985).
TL;DR: The prospective data in patients with NIDDM suggest that hyperglycemia is a risk factor for cardiovascular disease, but insufficient data exist to determine whether there is a glycemic threshold for macrovascular disease.
Abstract: Purpose: To report the progress (after 9-year follow-up) of a study designed to determine whether improved glucose control in patients with newly diagnosed non–insulin-dependent diabetes mellitus (...
TL;DR: It is difficult for the practitioner to define the potential role of somatostatin receptor scintigraphy in the evaluation of a patient with a gastroenteropancreatic syndrome because many studies do not provide the data needed and it remains unclear whether additional localization studies are helpful.
Abstract: Objective: To compare the sensitivity of somatostatin receptor scintigraphy done using [111In-DTPA-DPhe1]octreotide with that of other imaging methods in the localization of gastrinomas in patients...
TL;DR: The hypothesis that the relative deficiency of vitamin D, as determined by dietary intake and serum levels, predisposes patients to progression of osteoarthritis of the knee is investigated.
Abstract: Background: Evidence suggests that pathophysiologic processes in bone are important determinants of outcome in osteoarthritis of the knee Low intake and low serum levels of vitamin D may compromis
TL;DR: The distribution of HCV genotypes in distinct geographic regions of the United States was evaluated and the clinical characteristics of and response to interferon therapy in patients with one of several HCV Genotypes was determined.
Abstract: Objective To study 1) the geographic distribution and clinical significance of hepatitis C virus (HCV) genotypes in the United States and 2) the influence of HCV genotypes on response to interferon therapy. Design Hepatitis C virus genotype was determined in 179 stored serum samples obtained from patients who were positive for antibody to HCV and for HCV RNA by using polymerase chain reaction. Setting Tertiary referral centers in four geographic regions of the United States. Patients Patients who visited medical centers in the Midwest (50 patients), Northeast (42 patients), Southeast (35 patients), and West (52 patients). Measurements Chaotropic lysis and isopropanol precipitation were used to extract RNA from serum. Polymerase chain reaction was done on the NS5 region and was followed by automated direct sequencing and genotyping of desalted amplification products. Results 104 patients (58%) had subtype 1a; 38 (21%) had subtype 1b; 4 (2%) had subtype 2a; 23 (13%) had subtype 2b; 8 (5%) had subtype 3a; and 2 (1%) had subtype 4a. Examination of the known risk factors for acquiring HCV showed no association between genotype and mode of acquisition (blood transfusion, injection drug use, employment at a health care facility) or histologic findings at presentation (mild active hepatitis, moderately active hepatitis, or cirrhosis). Sixty-eight percent of patients with genotype 1a, 80% of patients with genotype 1b, and 37% of patients with genotype 2a or 2b had severe hepatitis. Thirteen of 46 (28%) patients with genotype 1a and 4 of 15 (26%) patients with genotype 1b had a complete biochemical response after 6 months of interferon therapy. In contrast, 10 of 14 (71%) patients with genotype 2a or 2b had a complete response to interferon therapy. Five of 39 (13%) patients with genotype 1a, 1 of 14 (7%) patients with genotype 1b, and 2 of 11 (18%) patients with genotype 2a or 2b had a sustained biochemical response. Conclusions In the United States, HCV genotypes 1a and 1b are the predominant genotypes in patients with chronic hepatitis C. Genotype is not correlated with mode of virus acquisition or with histologic findings at presentation. Patients with HCV genotype 1a or 1b had more severe liver disease and lower rates of response to interferon therapy than did patients with HCV genotype 2a or 2b. These findings may have implications for predicting outcome and selecting patients for interferon treatment.
TL;DR: This strategy was extended by nebulizing prostacyclin and a stable analog, iloprost, in patients with severe pulmonary hypertension, and achieved selective pulmonary vasodilatation with a concomitant improvement of ventilation-perfusion matching in mechanically ventilated patients with the adult respiratory distress syndrome.
Abstract: Objective: To compare the effects of aerosolization of prostacyclin and its stable analog iloprost with those of nasal oxygen, inhaled nitric oxide, and intravenous prostacyclin on hemodynamics and
TL;DR: In this article, the authors used Monte Carlo simulation to determine the cost of preventing vision loss in patients with diabetes mellitus through ophthalmologic screening and treatment and to calculate the cost-effectiveness of these interventions as compared with that of other medical interventions.
Abstract: Objective : To determine, from the health insurer's perspective, the cost of preventing vision loss in patients with diabetes mellitus through ophthalmologic screening and treatment and to calculate the cost-effectiveness of these interventions as compared with that of other medical interventions. Design : Computer modeling, incorporating data from population-based epidemiologic studies and multicenter clinical trials. Monte Carlo simulation was used, combined with sensitivity analysis and present value analysis of cost savings. Results : Screening and treatment of eye disease in patients with diabetes mellitus costs $3190 per quality-adjusted life-year (QALY) saved. This average cost is a weighted average (based on prevalence of disease) of the cost-effectiveness of detecting and treating diabetic eye disease in those with insulin-dependent diabetes mellitus ($1996 per QALY), those with non-insulin-dependent diabetes mellitus (NIDDM) who use insulin for glycemic control ($2933 per QALY), and those with NIDDM who do not use insulin for glycemic control ($3530 per QALY). Conclusions : Our analysis indicates that prevention programs aimed at improving eye care for diabetic persons not only result in substantial federal budgetary savings but are highly cost-effective health investments for society. Ophthalmologic screening for diabetic persons is more cost-effective than many routinely provided health interventions. Because diabetic eye disease is the leading cause of new cases of blindness among working-age Americans, these results support the widespread use of screening and treatment for diabetic eye disease.
TL;DR: In this historical review, war-related syndromes from the U.S. Civil War to the Persian Gulf War were analyzed to identify possible unifying factors.
Abstract: Purpose: To better understand the health problems of veterans of the Persian Gulf War by analyzing previous war-related illnesses and identifying possible unifying factors. Data Source: English-lan...
TL;DR: To investigate cross-reactivity between Bartonella species and Chlamydia species, serum specimens were adsorbed with Renografin-purified, and three epidemiologic featureshomelessness, alcoholism, and contact with catswere specifically sought.
Abstract: Background: Bartonella species are emerging pathogens that are seldom reported as a cause of blood culture-negative endocarditis. Objective: To report the occurrence of, risk factors for, and clini...